Interview Release Consent Form printable pdf download

Interview Release Consent Form

You (the interviewee)

have been asked for

information by myself (the interviewer)

, a

scholar affiliated with the [university and department name], to be used for preparing a

history of or a publication about _

I may be reached by email at

or by

phone at

You will be asked about

. The

anticipated length of the first interview is one to two hours. You may be asked to

participate in further interviews, which you may accept or decline. You are not required

to answer any questions that you do not wish to answer.

I will make a recording of your interview, which will then be used for scholarly

publications, or for other related educational purposes.

, have read the above, and I knowingly and

voluntarily permit

the full use of this information and

authorize her/him to publish this information. I understand that the recordings made

during the interview may eventually be donated to an archive.

(Interviewee Signature)

(Date)

Interview Release Consent Form